Abstract TP219: Can Pre-hospital Intervention Improve Rural Stroke Care?

Abstract

Background: In the stroke belt, local rural hospitals have reported 29 - 32% tissue plasminogen activator (tPA) treatment within 60 minutes for ischemic strokes. Since 2008, telemedicine has improved the door to treatment time from 120+ minutes to 70 minutes. A six month pilot program was initiated to determine the feasibility of a pre-hospital intervention to reach the American Stroke Association (ASA) target of 50% treatment within 60 minutes. Nine rural hospital sites were designated as Stroke Ready Hospitals (SRHs). Local emergency medical service (EMS) providers to these sites received additional education to evaluate and transport suspected stroke patients to the SRH in their area. The study also evaluated the early acute hospital patient care for improvements in treatment rates and data reporting at each SRH site. Hypothesis: Within six months, the SRHs will have 30-50% improvement rates in pre-notification by their local EMS providers and these will correspond to decreased triage time. Methods: This study assessed the benefit of early pre-notification by local EMS providers on decreased time to treatment and improved triage time as an improved process of care after implementation in nine SRH designated sites. To measure improvements in time to treatment and treatment rates, we compared time and treatment rates before (baseline was 11 months pre-study) and after study implementation in the same hospital sites. Results: A total of 6,049 transports were made by the EMS services with 117 patients suspected as strokes. A medical public safety answering point (PSAP) communication network provided stability in EMS data acquisition and stroke code notification to SRHs. The study showed improvements in mean triage and transport time vs. baseline (30.7 vs. 74 min, n=48 and n=22, respectively), Door to CT time vs. baseline (21 vs. 26 min, n=151 and =218, respectively) and Door to tPA time vs. baseline (65 vs. 78 min, n=13 and =22, respectively). While the ASA goal of 50% was not met, the % of treated ≤ 60 min increased from baseline at 24.8 to 38%. Pilot study code stroke % pre-notification increased from 38 to 69%. Conclusions: Pre-hospital intervention with local EMS providers improved pre-notification, first medical contact to CT time and the arrival time to treatment.